Impact of Serum Prolactin and Testosterone Levels on the Clinical Parameters of Dry Eye in Pregnant Women

Purpose. To explore the relationship between serum prolactin, testosterone level, and tear film parameters. The potential impact of these hormones on the health of the ocular surface in pregnant women was evaluated. Methods. This was a hospital-based cross-sectional study in which ocular symptoms (Ocular Surface Disease Index (OSDI)), tear function (fluorescein tear breakup time, Schirmer’s test 1), corneal and conjunctival staining, meibomian gland (MG) expressibility, and quality of secretion were measured. Lid margin findings including lid notching, thickness, and lid margin telangiectasia were also recorded. Venous blood was collected and the serum concentrations of prolactin and testosterone were determined using ELISA kits. Correlation and multiple linear regression analyses were used to examine predictors of dry eye symptoms and signs. Results. A total of 160 pregnant women participated in the study and their mean age was 30.1 ± 4.6 years (range 18–42 years). The correlation analysis indicated that testosterone concentration did not significantly correlate with any of the clinical parameters hence it was not included in the linear regression analysis. However, prolactin serum concentration correlated significantly with Schirmer’s test 1. Multiple linear regression was done to predict participants’ Schirmer’s test 1 score based upon their ocular surface staining score (oxford grading scale), meibomian gland expressibility, meibomian secretion quality, and serum concentration of prolactin. Only predictors that significantly correlated with Schirmer’s test 1 in the correlation analysis were included in the linear regression analysis. A significant regression equation was obtained (F (2, 157) = 5.119, p=0.007) with an R square of 0.05. Multiple linear regression analysis revealed that concentration of prolactin (ß coefficient = 0.032, p=0.044) and meibomian gland expressibility scores (ß coefficient = 2.14, p=0.016) were associated with Schirmer’s test 1 scores when adjusted for duration of pregnancy. Conclusion. The study showed that increased serum prolactin levels have a weak but positive impact on Schirmer’s test 1 scores whilst serum testosterone level has no association with the clinical parameters of dry eye in pregnant women

Vitamin D Deficiency Is Common in Ghana despite Abundance of Sunlight: A Multicentre Comparative Cross-Sectional Study

Background. Vitamin D is a steroid hormone important for the normal functioning of the body. It is produced through skin exposure to sunlight and from the diet. Although Ghana is located in the tropics where sunlight is abundant, factors like culture, diet, skin pigmentation, variation in the ozone layer, and geographical area influence the optimization of vitamin D concentration. It is imperative to evaluate the interplay between sunshine exposure, proinflammatory cytokines, and mediators of vitamin D metabolism and their relationship to vitamin D status in three geographical sections among apparent healthy Ghanaians. Methods and Results. In a cross-sectional study, a total of five hundred (500) healthy blood donors from three geographical areas in Ghana were enrolled. Their age ranged from 17 to 55 years with a mean age of 27.97 ± 8.87 years. The overall prevalence rate of vitamin D deficiency was 43.6% (218/500), with 41.2% (91/221), 45.3% (63/139), and 45.7% (64/140) of vitamin D deficiency being recorded in participants from the Northern Sector (NS), Middle Belt (MB), and Southern Sector (SS), respectively. However, there were no significant differences in the proportions of vitamin D deficiency across various geographical sectors. The median 25-hydroxyvitamin D serum levels were compared among geographical areas (NS, MB, and SS) and there were no significant differences (P=0.275) after adjusting for confounding factors. 25-Hydroxyvitamin D correlated positively with corrected ionized calcium (rs = 0.622, P≤0.001) and phosphorus (rs = 0.299, P≤0.001) and negatively correlated with SBP (rs = −0.092, P=0.039), vitamin D binding protein (VDBP) (rs = −0.421, P≤0.001), intact parathyroid hormone (iPTH) (rs = −0.0568, rs ≤ 0.001), IFN-gamma (rs = −0.684, P≤0.001), and TNF-alpha (rs = −0.600, P≤0.001). After adjusting for possible confounders, not having knowledge about vitamin D foods, taking fewer vitamin D foods, and higher levels of IF-γ and IL-10 were associated with a higher risk of having vitamin D deficiency. Conclusion. The prevalence of 25-hydroxyvitamin D deficiency is high among the general adult population in Ghana despite the abundance of sunlight. Increasing knowledge on vitamin D diet coupled with a daily intake of vitamin D dietary supplements is likely to reduce the risk of developing 25-hydroxyvitamin D deficiency

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways